Impact of Sugar-Sweetened Beverage Taxation Scenarios in Germany: A Comparative Modelling Study

Abstract Objectives Taxing sugar-sweetened beverages (SSBs) is recommended to reduce the burden of obesity, cardiovascular disease (CVD) and type 2 diabetes (T2DM). The objective of this study was to quantify the potential long-term health and economic impact of different SSBs taxation scenarios in Germany using simulation models with different granularity. Methods We used a multi-state life table Markov cohort (MSLT) and a microsimulation (IMPACT) model to simulate the impact of different SSB taxation assumptions and scenarios on CVD and T2DM in the German population aged 20 years and older over 20 years. Data sources included official population counts, anthropometric and dietary intake data from national surveys and published meta-analyses. Change in beverage consumption by sex and age under different taxation scenarios was estimated using de-novo national price elasticities and changes in body weight were based on an energy equilibrium model. We projected incremental disability-adjusted life years (DALYs) and healthcare costs, comparing results between both models. Results Preliminary results from the MSLT model show that a 20% SSB excise tax in Germany could lead to moderate body weight reductions across all age-sex groups. Over 20 years, the tax would reduce healthcare costs by €753 million [95% CI: 527; 1,021] and save 24,380 DALYs [18,460; 33,900] from T2DM alone. Health and economic gains largely depend on the relevance of substitution effects, tax amount and taxed beverage categories. Results including CVD and comparisons with the IMPACT model are work-in-progress. Conclusions We show that SSBs taxation in Germany has the potential to reduce healthcare costs and improve population health. The impact of any SSB tax depends on its implementation scenario, which behavioural assumptions hold, and the obesity-related disease outcomes considered for its evaluation. Further research should compare various obesity prevention approaches to support health policy priority setting. Key messages • Taxation of sugar-sweetened beverages can reduce healthcare costs and improve population health in Germany. • The estimated health and economic impact of sugar-sweetened beverage taxation critically depends on tax design and behavioural modelling assumptions.


Introduction:
After the Berlin terrorist attack at Breitscheidplatz, the genderspecific evaluation of emergency responders (ER) revealed higher perceived levels of paranoid ideation among females. The occupation-specific evaluation revealed higher hostility among police officers and a lower quality of life among firefighters. The aim of this study was to examine the outcome of crisis intervention (CI) provided for ER deployed to this terrorist attack.

Methods:
In total, N = 55 ER were included (n = 37 with and n = 18 w/ o CI). Stress, quality of life, post-traumatic stress disorder, and current psychological stress were assessed 4 months after the attack.

Conclusions:
This study provides evidence for differences in the mental health burden for ER with and w/o CI, in general and for subgroups of gender and occupation. There is no conclusive explanation for why ER with CI score worse on certain measures. It is possible that CI had a harmful influence due to the reinforcement of negative emotions in some parts of measures like the Critical Incident Stress Debriefing (CISD). While it is known that ERs are vulnerable to develop mental problems, and appropriate and timely help is recommended, it is important to critical evaluate the methods used and to take also into account the identified gender and occupational differences. Further research is needed to better understand the interaction of risk factors.

Background:
Interpretive Front-of-Pack Labels (FoPLs) are supported by WHO as a key policy tool to promote healthy diets. At present, various FoPLs formats co-exist in the European Union (EU). However, as part of the Farm to Fork strategy, the European Commission stated it would adopt a single mandatory FoPL in 2022. The aim of this study was to analyze Spanish consumers reactions to Nutri-Score and NutrInform, two FoPLs that are currently the subject of debate in EU, testing preference through subjective understanding and perception but also performance through objective understanding of the FoPLs.

Methods:
The experimental study was conducted in 2021 on a representative sample of 1026 Spanish adults (50% women, mean ageAESD = 46AE14 years), through an online randomized questionnaire where participants were exposed to Nutri-Score or NutrInform. Performance of and preference for these two FoPLs were assessed in three food categories (Breakfast Products, Breakfast Cereals and Added Fats). Performance was tested using multivariate logistic regression while preference using principal component analysis and t-tests.

Results:
In terms of objective understanding, Nutri-Score was significantly associated with an increase in consumers' ability to identify healthier food products across all food categories compared to NutrInform (OR = 19.1 [14.2-25.7], p < 0.0001). On the preference dimension, Nutri-Score was perceived as significantly easier to use and was more liked than NutrInform (standardized PCA dimension resp. 0.32AE1.58 vs. -0.29AE1.66, p < 0.0001 and 0.080AE1.18 vs. -0.072AE1.17, p = 0.039) and participants found Nutri-Score more helpful to discriminate and type 2 diabetes (T2DM). The objective of this study was to quantify the potential long-term health and economic impact of different SSBs taxation scenarios in Germany using simulation models with different granularity.

Methods:
We used a multi-state life table Markov cohort (MSLT) and a microsimulation (IMPACT) model to simulate the impact of different SSB taxation assumptions and scenarios on CVD and T2DM in the German population aged 20 years and older over 20 years. Data sources included official population counts, anthropometric and dietary intake data from national surveys and published meta-analyses. Change in beverage consumption by sex and age under different taxation scenarios was estimated using de-novo national price elasticities and changes in body weight were based on an energy equilibrium model. We projected incremental disability-adjusted life years (DALYs) and healthcare costs, comparing results between both models.

Results:
Preliminary results from the MSLT model show that a 20% SSB excise tax in Germany could lead to moderate body weight reductions across all age-sex groups. Over 20 years, the tax would reduce healthcare costs by E753 million [95% CI: 527; 1,021] and save 24,380 DALYs [18,460;33,900] from T2DM alone. Health and economic gains largely depend on the relevance of substitution effects, tax amount and taxed beverage categories. Results including CVD and comparisons with the IMPACT model are work-in-progress.

Conclusions:
We show that SSBs taxation in Germany has the potential to reduce healthcare costs and improve population health. The impact of any SSB tax depends on its implementation scenario, which behavioural assumptions hold, and the obesity-related disease outcomes considered for its evaluation. Further research should compare various obesity prevention approaches to support health policy priority setting.

Key messages:
Taxation of sugar-sweetened beverages can reduce healthcare costs and improve population health in Germany. The estimated health and economic impact of sugarsweetened beverage taxation critically depends on tax design and behavioural modelling assumptions.
Abstract citation ID: ckac129.341 How much of the unemployment effect on mental health is due to income? Mediation analysis in UK data

Background:
Employment and income are important determinants of mental health (MH), but the extent to which unemployment effects are mediated by reduced income is unclear. We estimated the total effect (TE) of unemployment on MH and the controlled direct effect (CDE) not acting via income.

Methods:
We studied adults 25-64y from nine waves of the representative UK Household Longitudinal Study (n = 45,497/ obs = 202,297). Unemployment was defined as not being in paid employment; common mental disorder (CMD) was defined as a General Health Questionnaire-12 score !4. We conducted causal mediation analysis using inverse probability of treatment weights to estimate odds ratios (OR) and absolute differences for the effects of unemployment on CMD as measured in the same sweep, before (TE) and after (CDE) blocking the income pathway.

Conclusions:
In the UK, a high proportion of the short-term effect of unemployment on MH is not explained by income, particularly for those who are younger or already living in poverty. Population attributable fractions suggested 16.5% of CMD burden was due to unemployment, with 13.9% directly attributable to job loss rather than resultant income changes. Further research is needed across different European countries to determine how different welfare regimes might moderate these effects, and to investigate longer-term effects. Key messages: Unemployment has a clear detrimental effect on MH in the short-term. Only a small proportion of this effect appears to be mediated by income.